Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

Harbottle, Stephen; Hughes, Caroline; Cutting, Rachel; Roberts, Steve; Brison, Daniel R.

doi:10.3109/14647273.2015.1083144

Cited by 59 publications

(29 citation statements)

References 153 publications

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“…Twin and multiple pregnancies are associated with high risks to both the pregnant woman and the potential children . Many countries, specifically those with state‐subsidized health insurance, have chosen to require single‐embryo transfer, with some exceptions . These policies have resulted in a substantial decrease in multiple births with a concomitant substantial reduction in morbidity and mortality.…”

Section: Request For Multiple‐embryo Transfermentioning

confidence: 99%

“…6 Many countries, specifically those with state-subsidized health insurance, have chosen to require single-embryo transfer, with some exceptions. 7 These policies have resulted in a substantial decrease in multiple births with a concomitant substantial reduction in morbidity and mortality. Success rates for IVF have remained fairly constant.…”

Section: Request For Multiple-embryo Transfermentioning

confidence: 99%

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Should Clinicians Set Limits on Reproductive Autonomy?

King¹

2017

Hastings Center Report

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As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree?

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Section: Request For Multiple‐embryo Transfermentioning

confidence: 99%

Section: Request For Multiple-embryo Transfermentioning

confidence: 99%

Should Clinicians Set Limits on Reproductive Autonomy?

King¹

2017

Hastings Center Report

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“…The purpose of this manuscript is to recapitulate a recent oral debate between a proponent and an opponent of expanded eSET utilization in an attempt to determine whether a blanket eSET policy, as is increasingly considered, is defensible 9. E.Y.A.…”

Section: Introductionmentioning

confidence: 99%

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Adashi¹,

Gleicher²

2017

Rambam Maimonides Med J

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For the purpose of reducing maternal and neonatal morbidity, elective single transfer (eSET) in in vitro fertilization (IVF) was first proposed in 1999. The purpose of this review is to summarize recent oral debate between a proponent and an opponent of expanded eSET utilization in an attempt to determine whether a blanket eSET policy, as is increasingly considered, is defensible. While eSET is preferable when possible, and agreed upon by provider and patient, selective double embryo transfer (DET) must be seriously entertained if deemed more appropriate or is desired by the patient. Patient autonomy, let alone prolonged infertility and advancing age, demand nothing less. Importantly, IVF-generated twins represent only 15.7% of the national twin birth rate in the United States. Non-IVF fertility treatments have been identified as the main cause of all multiple births for quite some time. However, educational and regulatory efforts over the last decade, paradoxically, have exclusively only been directed at the practice of IVF, although IVF patient populations are rapidly aging. It is difficult to understand why non-IVF fertility treatments, usually applied to younger women, have so far escaped attention. This debate on eSET utilization in association with IVF may contribute to a redirection of priorities.

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“…3 The multiple birth rate that was associated with ART in 2013 varied worldwide, with an incidence of <10% in Sweden, Finland, Belgium, and Quebec province (Canada); 10%-20% in other European countries; and 28.3% in the USA. 4 Japan is among the nations where the multiple birth rate that is associated with ART is the lowest. Although safer pregnancies have been provided with SET and "all freeze" by the avoidance of multiple births and severe OHSS, it is anticipated that the treatment period and medical care costs for couples to achieve their first live birth (LB) have increased.…”

Section: Introductionmentioning

confidence: 99%

Treatment period and medical care costs to achieve the first live birth by assisted reproductive technology are lower in the single embryo transfer period than in the double embryo transfer period: a retrospective analysis of women younger than 40 years of age

Kawahara

Ueda

Nakahori

et al. 2017

Reprod Medicine & Biology

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AimIt was examined whether the single embryo transfer policy makes the treatment period longer for couples to achieve their first live birth by assisted reproductive technology.MethodsThis study retrospectively analyzed women who started assisted reproductive technology at younger than 40 years of age in the authors’ organization. The treatment periods for couples to achieve the first live birth by assisted reproductive technology, between the women who started assisted reproductive technology from 2004 to 2009 (the double embryo transfer period group, n=250), in which the double embryo transfer was predominant, and the women who started assisted reproductive technology from 2010 to 2015 (the single embryo transfer period group, n=298), in which the single embryo transfer was predominant, were compared.ResultsThe age at the start of assisted reproductive technology, pregnancy rate per embryo transfer, and rate of women who achieved a live birth by assisted reproductive technology per number of women who tried assisted reproductive technology were all significantly higher in the single embryo transfer period group. Among the women who achieved a live birth by assisted reproductive technology, the incidence of multiple births and severe ovarian hyperstimulation syndrome, the treatment period, and medical care costs needed to achieve the first live birth were all significantly lower in the single embryo transfer period group.ConclusionIn the single embryo transfer period group, those women who were younger than 40 years of age achieved their first live birth by assisted reproductive technology more safely, quickly, and reasonably.

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Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

Cited by 59 publications

References 153 publications

Should Clinicians Set Limits on Reproductive Autonomy?

Should Clinicians Set Limits on Reproductive Autonomy?

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Treatment period and medical care costs to achieve the first live birth by assisted reproductive technology are lower in the single embryo transfer period than in the double embryo transfer period: a retrospective analysis of women younger than 40 years of age

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